Collector II: Revenue Cycle Operations

Job Description Responsible for working with insurance companies, government payors, and patients for resolution of payments and account issues. Responsibilities Serve as the account representative for Hoag in collating with insurance companies, government payors, and patients for resolution of payments and account resolution. Complete assigned accounts within assigned work queues. Obtain maximum reimbursement by evaluating claims at the contract rate using the contract management tool for proper pricing (e.g., APC, DRG, APRDRG). Review and initiate initial appeals for underpayments, observing all timely requirements to secure reimbursement due to Hoag. Review and complete payor and/or patient correspondence in a timely manner. Escalate to payor and/or patient accounts that need to be appealed due to improper billing, coding, or underpayments. Report new/unknown billing edits to direct supervisor for review and resolution. Understand the Revenue Cycle processes from Patient Access through Patient Financial Services, including procedures and policies. Have thorough knowledge of managed care contracts, current payor rates, terms and conditions, and federal and state requirements. Interpret Explanation of Benefits (EOBs) and Electronic Admittance Advices (ERAs) to ensure proper payment and assist patients and colleagues in understanding benefit plans. Know hospital billing form requirements (UB04) and be familiar with HCFA 1500 forms. Know various payer types (HMO, POS, PPO, EPO, IPA, Medicare Advantage, Covered California, etc.) and how they process claims. Demonstrate knowledge of and effectively use patient accounting systems. Document all calls and actions taken in the appropriate systems. Accurately code insurance plan codes. Establish payment arrangements when patients are unable to pay in full at the time payment is due. Review applicable cash rates, special rates, professional and employee discounts. Process bankruptcy and deceased patient accounts. Perform other duties as assigned. Consistently meet individual productivity and quality assurance standards. Demonstrate proficiency in the functions above as a Collector II. Assist in multiple areas, payors or departments. Help with special projects and/or additional tasks as needed. Problem‑solve issues as they arise and independently research solutions for resolution. Provide support and assist with training peers as needed. Exceed productivity and quality assurance standards for at least 6 consecutive months. No corrective action within the last 6 months. Education and Experience High school diploma or equivalent required. Three years of experience in a hospital/medical or related field, or strong background in customer service. Working knowledge of Epic Resolute, Eric Care, and Epic CPOE. Intermediate Excel knowledge is a must. Hoag is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. Hoag is committed to equal employment opportunity for all employees and a work environment free of discrimination and harassment. Hoag hires a diverse group of people in a manner that allows them to reach their full potential in the pursuit of organizational objectives. #J-18808-Ljbffr